Determinants of the in-hospital outcome of spontaneous ich in a developing country in the ct era: A neurosurgical prospective analytical study [Bt cağında spontan ish olgularında gelişmekte olan bir ülkede sonuç belirleyiciler: Norosirurjikal acıdan prospektif bir çalışma]

Introduction: as in most low-middle income countries (lmic) there is dearth of original reports on the outcome of spontaneous intracerebral haemorrhage (sich) from sub-saharan africa (ssa). methods: this is a 5-year prospective consecutive study of cases of sich referred for operative care in an ssa neurosurgeon's practice. the in-hospital outcome was assessed and the determinants thereof were interrogated using univariate and multivariate logistic regression analyses. results: there were 63 subjects,38 (60.3%) males,aged 28-85years,mean 55.7 (sd,12.7). clinical presentation was in poor prognostic stage in most: >57% in coma; significant mass effect on brain ct in 78.3% and associated ivh in 65%. surgical evacuation of ich was offered 23 patients (36.5%),more likely in those with mass effect on ct. in-hospital mortality was 62.3%,and good outcome on dichotomized mrs- 27.4%. these proportions were similar between the surgical and non-surgical patient sub-groups. on univariate analysis,statistically significant clinical-radiological associations of these outcomes (p<0.05 in each case) include presentation in coma,unadjusted or (95% ci) 24.73 (4.90-124.90); in state of critical illness,28.00 (6.58-119.23); with respiratory distress/aspiration pneumonitis,12.31 (3.04-49.77),and ich with associated ivh,6.48 (1.86-22.61). on multivariate binary logistic regression analysis,only presentation in a state of critical illness was predictive of death,adjusted or 97.32(3.67-2583.93,p <0.01). conclusion: in this typical sub-sahara african lmic,spontaneous ich presents in poor prognostic mode,with coma and general critical illness. in-hospital outcome was poor in this study subjects,notwithstanding the definitive treatment,with/without surgery,received. © 2016,ege university press. all rights reserved.